Earlier Use of Novel Agents Promising for Older Patients with Hodgkin Lymphoma

Debu Tripathy, MD

IN THIS SPECIAL ISSUE of CURE®, among other highlights in the treatment of blood cancers, we detail yet another example of a new application for immunotherapy, this time focusing on the use of PD-1 (checkpoint) immunotherapy to treat Hodgkin lymphoma.

The recent approval of the immunotherapy Opdivo (nivolumab) for use in this disease is giving doctors hope that they can increase a cure rate that is already as high as 85 percent. And while Opdivo is now used later in the course of treatment, after patients have experienced disease progression on other therapies, scientists are studying the use of this immunotherapy as an initial therapy. That could be especially advantageous for patients over the age of 60 who have Hodgkin lymphoma — a population that represents 20 percent of people with the disease.

Typically, these patients experience worse outcomes than their younger counterparts. Why is this? In other cancers, especially breast cancer, older patients are often undertreated for fear that they won’t cope well with the side effects of various therapies. But in Hodgkin lymphoma, older patients often get standard-of-care treatment, which tends to center around chemotherapy cocktails. Even when there’s no difference in disease progression among the two groups, the mortality rate has proven to be much higher in patients aged 60 and older than in their younger counterparts. In this population, then, it does seem that physical decline due to age can affect responsiveness to cancer treatment.

It seems reasonable to imagine that more tolerable regimens would help change those outcomes for patients who may have other coexisting medical problems, but we can’t prove that yet, since the studies so far on this issue are inadequate. The time is ripe, though, to rejuvenate that effort, and scientists are doing just that as they study whether some of the latest therapies for Hodgkin lymphoma may be useful for older patients earlier in the course of treatment, and whether these treatments will boast at least comparable effectiveness with fewer toxicities. Among these therapies are the antibody-drug conjugate Adcetris (brentuximab vedotin), which works by finding cancer cells that carry a specific cancer-related protein and then destroying the cells with chemotherapy; Opdivo; and a similar immunotherapy, Keytruda (pembrolizumab).

Not every older person who has cancer is fragile or suffers with additional health problems, and age alone should not dictate that someone steer clear of standard therapies. If you are older, ask your doctor to conduct a geriatric assessment to determine whether you are eligible for standard care or would fare better on gentler treatment. For those who face a tough road on standard chemotherapy, immunotherapy or Adcetris might soon become meaningful medical alternatives, but this still needs further study. Read ahead as we share findings with you about the safety and effectiveness of these approaches, and about whether — or when — they might be woven into routine practice.

DEBU TRIPATHY, MDEditor-in-ChiefProfessor of MedicineChair, Department of Breast Medical OncologyThe University of Texas MD Anderson Cancer Center